It's not a healthcare plan, like a Health Maintenance Organization (HMO). It's not insurance coverage. It's not Medicaid-For-All. It doesn't set costs for medical care or insurance.
It's not even "Obamacare", which started out as a pejorative by those opposed to it. It's correct name was the Patient Protection and Affordable Care Act, the PPACA, or ACA for short.
It is comprehensive legislation that had as its goal making healthcare affordable and accessible.
Some of its features are:
- Prohibits lifetime monetary caps on health insurance plans.
- Forbids insurers from canceling health insurance unless there’s fraud.
- Doesn’t allow health insurers to deny coverage because of preexisting conditions.
- Prohibits insurers from charging higher rates based on health.
- Requires that insurers use at least a minimum percentage of premiums to pay for members’ medical services.
- Allows parents to keep children on their health insurance until the age of 26.
- Offers subsidies based on income that help cut health insurance costs for Americans who qualify.
- Allows states to expand Medicaid to more people by lowering income requirements to get coverage.
The most visible feature of the ACA is the Marketplace Exchanges, where individual health insurance plans can be purchased. Those who use these plans are eligible for subsidies based on income. Individual insurance could always be purchased, but most people get their health insurance though group plans at their job, This is fairly unique.
Prior to World War II insurance was purchased exclusively on an individual basis. However, due to the competition for workers caused by so many young men joining the military, businesses were in a bidding war for those who remained. The government mandated a wage freeze to put a stop to it. Companies found a way around the mandate: offering benefits, such as health insurance, in lieu of a pay rate increase. After the war, this system was well established, continuing to the present day. Unless you were self-employed, you got your health insurance from your employer. Losing one's job put you in the position of being uninsured.
The ACA's intent was to make it easier for people who were unemployed or self-employed to purchase insurance, and to make existing insurance plans more customer-friendly. One of the basics of any kind of insurance is shared risk. Not everyone needs it all the time. Typically, younger people are healthier and make fewer claims than older people. The younger, healthier insured effectively subsidize the older people...and hopefully will someday become older people. One of the requirements of the ACA was that most people be insured or pay a penalty. This was to increase the pool of insured people, theoretically keeping costs reasonable. (There were exceptions, income based, and some others). The penalty was ruled unconstitutional and no longer exists.
The subsidies were what made marketplace exchange plans affordable, at least in theory. After I lost my job, and my group health insurance through my employer, I was on an ACA subsidized plan until I found a new job. It was a fraction of what I would have paid if I had remained on the COBRA plan through my former employer. The problem was that there was no restriction on what companies could charge for premiums, and plans could often still be out of reach, even after subsidies. But even so, there are millions who would be uninsured without the subsidies.
Other aspects of the ACA are important as well. Before the ACA, many people were ineligible for insurance because they had a pre-existing condition—something that the insurance company knew that they would have to spend a lot of money covering. The prohibition on different rates for different health conditions was something that benefitted many. The company where I was employed pre-ACA charged a higher premium if you scored too low on an annual health assessment. many of the criteria were arbitrary and were often impossible to meet unless you were a twenty year old athlete.
The Republicans have been saying since the passing of the ACA that they want to repeal it and replace it with "something better". They have failed, time and time again to get rid of it, even when they are in the majority. I've never even heard a broad outline, a "concept of a plan" if you will. What is it that they don't like? The only complaints that I have ever heard is that it's too expensive. What is their plan to make insurance more affordable? I suspect that they would suggest rolling back some of the requirements, theoretically making premiums cheaper. But there's no guarantee that insurance companies would reduce premiums, opting instead to just reap greater profits.
But right now—in two months—the subsidies are expiring and people will either lose their insurance or pay substantially higher premiums. The Democrats are using the tiny bit of leverage that they have to try to extend the subsidies, what are the Republicans doing?
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